Stroke impact on mortality and psychologic morbidity within the Childhood Cancer Survivor Study

Abstract

Background:

Poor socioeconomic and health-related quality of life (HRQOL) outcomes in survivors of childhood cancer can lead to distress and overall negatively impact individuals’ lives. The current report highlights the impact of stroke and stroke recurrence on mortality, psychological HRQOL and socioeconomic outcomes within the Childhood Cancer Survivor Study (CCSS).

Patients and Methods:

CCSS is a retrospective cohort study with longitudinal follow-up on pediatric cancer survivors diagnosed between 1970–1986. Mortality rates (MR) per 100 person-years were calculated across three periods: (1) prior to stroke; (2) after first stroke, before recurrent stroke; and (3) post recurrent stroke. Socioeconomic outcomes, standardized Brief Symptoms Inventory-18, Short-Form Health Survey-36, and CCSS Neurocognitive Questionnaire were also assessed.

Results:

Among 14,358 participants (median age 39.7 years), 224 had a stroke after cancer diagnosis (single stroke n=161; recurrent stroke n=63). Based on 2,636 deaths, all-cause late MR were 0.70 (95% confidence intervals [CI] 0.68–0.73) prior to stroke, 1.03 (95% CI 0.73–1.46) after first stroke, and 2.42 (CI 1.48–3.94) after recurrent stroke. Among 7,304 survivors, those with stroke were more likely to live with a caregiver (single stroke odds ratio [OR] 2.3 [CI 1.4–3.8]; recurrent stroke OR 5.3 [CI 1.7–16.8]) compared to stroke free survivors. Stroke negatively impacted task efficiency (single stroke OR 2.4 [CI 1.4–4.1]; recurrent stroke OR 3.3 [CI 1.1– 10.3]) and memory (single stroke OR 2.1 [CI 1.2–3.7]; recurrent stroke OR 3.5 [CI 1.1– 10.5]).

Conclusions:

Stroke and stroke recurrence are associated with increased mortality and negatively impact HRQOL measures in pediatric cancer survivors.

Summary:

Within the CCSS cohort, stroke and stroke recurrence were significantly associated with increased all-cause mortality. Survivors who experienced a stroke were significantly more likely to have neurocognitive problems, live with a caregiver and be unemployed compared to stroke-free survivors.